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Xie F, Agrawal S, Johnson EF, Wieland CN, Davis DMR, Theiler RN, Lehman JS. Updates on the dermatopathology of pregnancy-associated skin conditions. Hum Pathol 2023; 140:173-195. [PMID: 37209919 DOI: 10.1016/j.humpath.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
Pathologists provide valuable input in the dermatological care of pregnant patients in various contexts. This article provides dermatopathology updates on cutaneous changes associated with pregnancy, organized based on the following classification system: physiological skin changes in pregnancy, specific dermatoses of pregnancy, dermatoses modified in pregnancy, and skin neoplasms in pregnancy. Awareness of the impact of pregnancy on the skin by pathologists is important, as this is an opportunity to contribute to diagnostic precision in this patient population.
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Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Shruti Agrawal
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Dawn Marie R Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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Niewozinska ZA, Dvoriankova EV, Tkachenko OI, Korsunskaya IM. Atopic skin lesions in pregnant women: how to help patients. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.12.201257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Many pregnant women experience skin symptoms caused by immunological, metabolic or other changes that occur in their body during pregnancy. One of the most common complaints of pregnant women is itchy skin. In about 20% of cases, itching in pregnant women is associated with atopic skin lesions. Histologically, these lesions are indistinguishable from atopic dermatitis, which also tends to worsen during pregnancy. It is believed that these lesions are due to increased production of Th2 cytokines (interleukin-4 and -10) in the body of a pregnant woman. Topical glucocorticosteroids and skin care products are best treatments for atopic skin lesions of pregnant women and exacerbation of atopic dermatitis. In cases of limited rashes or mild dermatitis, only care products with a strong moisturizing effect can be used. Using moisturizers can help minimize itching and skin discomfort. One of these agents that we use in practice is XeraCalm A.D Lipid-Replenishing cream, the unique formula of which not only has a regenerating and antipruritic effect, but also enhances the natural immunity of the skin.
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Cosgarea I, Trevisan-Herraz M, Ungureanu L, Zalaudek I. Dermatoscopic Features of Naevi During Pregnancy-A Mini Review. Front Med (Lausanne) 2021; 8:727319. [PMID: 34434949 PMCID: PMC8381148 DOI: 10.3389/fmed.2021.727319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Changes in melanocytic naevi and development of new naevi have been reported in pregnant women. The association between pregnancy and melanoma is a controversial topic. We conducted this review to identify the dermatoscopic changes that occur in naevi during pregnancy that could facilitate in distinguishing benign from suspicious lesions. Medline, Scopus, and Embase datasets were reviewed for clinical studies on dermatoscopic characteristics of melanoma and naevus in pregnancy. Six cohort studies with a total of 258 patients with 1,167 skin lesions that were examined fulfilled the conditions to be included in the review. None of the patients developed melanoma. Development of new naevi, when reported, was observed in less than half of the participants. The most frequent observed dermatoscopic change among the studies was the increase in the number of dots. Development of new vessels, hypo- and hyperpigmentations and changes in the pigment network were common described changes. The included studies were heterogeneous not allowing head-to-head comparisons between them. Robust and larger studies of dermatoscopic evaluation of naevi in pregnant women are needed to determine high-risk dermatoscopic characteristics.
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Affiliation(s)
- Ioana Cosgarea
- Newcastle upon Tyne Hospitals National Health Service Trust, Newcastle Oncology and Dermatology, Newcastle upon Tyne, United Kingdom.,Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Loredana Ungureanu
- Department of Dermatology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
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Molecular Profiling of Noncoding Mutations Distinguishes Nevoid Melanomas From Mitotically Active Nevi in Pregnancy. Am J Surg Pathol 2019; 44:357-367. [DOI: 10.1097/pas.0000000000001406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harvey NT, Wood BA. A Practical Approach to the Diagnosis of Melanocytic Lesions. Arch Pathol Lab Med 2018; 143:789-810. [PMID: 30059258 DOI: 10.5858/arpa.2017-0547-ra] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Melanocytic lesions are common in routine surgical pathology. Although the majority of these lesions can be confidently diagnosed using well-established morphologic criteria, there is a significant subset of lesions that can be diagnostically difficult. These can be a source of anxiety for patients, clinicians, and pathologists, and the potential consequences of a missed diagnosis of melanoma are serious. OBJECTIVE.— To provide a practical approach to the diagnosis of melanocytic lesions, including classic problem areas as well as suggestions for common challenges and appropriate incorporation of ancillary molecular techniques. DATA SOURCES.— Literature search using PubMed and Google Scholar, incorporating numerous search terms relevant to the particular section, combined with contemporaneous texts and lessons from personal experience. CONCLUSIONS.— Although a subset of melanocytic lesions can be diagnostically challenging, the combination of a methodical approach to histologic assessment, knowledge of potential diagnostic pitfalls, opinions from trusted colleagues, and judicious use of ancillary techniques can help the pathologist navigate this difficult area.
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Affiliation(s)
- Nathan T Harvey
- From the Dermatopathology Group, Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia; and the Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, Australia
| | - Benjamin A Wood
- From the Dermatopathology Group, Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia; and the Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, Australia
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Abstract
The management of melanoma during pregnancy is challenging as maternal benefits and fetal risks need to be balanced. Here, we present an overview of the incidence, the demographic and clinical characteristics and the treatment modalities used. After analysis of obstetric, fetal and maternal outcome, recommendations for clinical practice are provided. From the 'International Network on Cancer, Infertility and Pregnancy' database, pregnant patients with melanoma were identified and analysed. Sixty pregnancies were eligible for analysis. Fifty percent of the patients presented with advanced melanoma during pregnancy (14 stage III and 16 stage IV), and 27% were diagnosed with recurrent melanoma. Surgery was the main therapeutic strategy during pregnancy. Only four patients with advanced melanoma were treated during pregnancy with systemic therapy (n=1) or radiotherapy (n=3). Premature delivery was observed in 18% of the ongoing pregnancies, all which were induced and 78% of which involved patients with advanced melanoma. Thirty-nine percent of the patients died within 5 years; all had been diagnosed with stage III or IV disease during pregnancy. Melanoma can present in a more advanced stage during pregnancy. New systemic therapies may be beneficial for patients with metastatic melanoma but may not be pregnancy compatible. In these patients, preterm induction of labour need to be discussed, despite the short-term and long-term negative effects on the child.
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Tchernev G, Dzhelyatova GA, Wollina U, Lozev I, Lotti T. Medium Sized Congenital Melanocytic Nevus with Suspected Progression to Melanoma during Pregnancy: What's the Best for the Patient? Open Access Maced J Med Sci 2018; 6:143-145. [PMID: 29484013 PMCID: PMC5816287 DOI: 10.3889/oamjms.2018.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/17/2017] [Accepted: 09/24/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Congenital melanocytic nevi (CMN) are pigmented skin lesions usually present at birth. Rare varieties can develop and become clinically very large. Although they are benign nevomelanocytic neoplasms, all CMN may be precursors of the melanoma, regardless of their size. Individual risk of malignant transformation of melanocyte is determined by simultaneous action of exogenous and endogenous factors. The major exogenous risk factor is ultraviolet radiation. Leading roles among the endogenous factors are attributed to skin phenotype, gene mutation, sex hormones and their significance. CASE REPORT: We present a case of a 27 – year - old pregnant female patient with a congenital melanocytic nevus, which increased significantly in size, during her pregnancy. Estrogen levels increase during pregnancy and clinical evidence has suggested that melanocytes are estrogen - responsive. Nevi in a pregnant patient would exhibit increased expression of estrogen receptor β (ERβ) and thus enhanced the potential to respond to altered estrogen levels. CONCLUSION: All pigmented skin lesions should be carefully observed during pregnancy by a dermatologist due to the increased risk of malignant transformation, associated with the endocrine dependence. All lesions with visible changes should be removed surgically with appropriative anaesthesia.
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Affiliation(s)
- Georgi Tchernev
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria.,"Onkoderma"- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | | | - Uwe Wollina
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Ilia Lozev
- Medical Institute of Ministry of Interior Department of General, Vascular and Abdominal Surgery, Sofia, Bulgaria
| | - Torello Lotti
- University G. Marconi of Rome - Dermatology and Venereology, Rome, Italy
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Melanocytic nevi and melanoma: unraveling a complex relationship. Oncogene 2017; 36:5771-5792. [PMID: 28604751 DOI: 10.1038/onc.2017.189] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 12/11/2022]
Abstract
Approximately 33% of melanomas are derived directly from benign, melanocytic nevi. Despite this, the vast majority of melanocytic nevi, which typically form as a result of BRAFV600E-activating mutations, will never progress to melanoma. Herein, we synthesize basic scientific insights and data from mouse models with common observations from clinical practice to comprehensively review melanocytic nevus biology. In particular, we focus on the mechanisms by which growth arrest is established after BRAFV600E mutation. Means by which growth arrest can be overcome and how melanocytic nevi relate to melanoma are also considered. Finally, we present a new conceptual paradigm for understanding the growth arrest of melanocytic nevi in vivo termed stable clonal expansion. This review builds upon the canonical hypothesis of oncogene-induced senescence in growth arrest and tumor suppression in melanocytic nevi and melanoma.
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Panicker VV, Riyaz N, Balachandran PK. A clinical study of cutaneous changes in pregnancy. J Epidemiol Glob Health 2016; 7:63-70. [PMID: 27870929 PMCID: PMC7320517 DOI: 10.1016/j.jegh.2016.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 07/06/2016] [Accepted: 10/19/2016] [Indexed: 11/25/2022] Open
Abstract
Background/objective: Pregnant women experience a myriad of physiological and metabolic changes that affect different organ systems in the body. Cutaneous and appendageal alterations that manifest during pregnancy are largely modulated by hormonal, immunologic, and metabolic factors. Detailed reports encompassing physiological changes and specific dermatoses of pregnancy and effects of various dermatoses on pregnant women are scanty in literature. This study was conducted to examine in detail both physiological changes and specific dermatoses. The cutaneous changes are divided into physiological changes, skin diseases aggravated by pregnancy, and specific dermatoses of pregnancy. The objectives were to study the various cutaneous changes of pregnancy and to know the proportion of these cutaneous manifestations in pregnant women. Methods: This study included 600 pregnant women attending the Obstetrics and Gynecology Department of a tertiary teaching hospital in Northern Kerala, India. Detailed history elicitation and complete physical and dermatological examination were performed. Skin biopsy was performed in relevant cases. Results: Cutaneous changes were seen in a majority of patients, of which physiological changes were the most common (99%). The most common cutaneous manifestation was hyperpigmentation (526; 87.6%), followed by striae gravidarum (72.8%). Other changes were vascular, including pedal edema (10%), pregnancy gingivitis (1.8%), and varicose veins (1%). Infections were the common dermatological problem in this study group. The most common infections were vulvovaginal candidiasis (21%), Tinea versicolor (6%), scabies (2.8%), dermatophytosis (1.5%), and sexually transmitted infection (0.5%). Specific dermatoses were seen in 12 cases (2%), with the most common being pruritic urticarial papules and plaques of pregnancy (1.3%). Conclusion: Pregnant women are prone to suffer from a wide range of dermatological problems apart from specific dermatoses of pregnancy. The study emphasizes the need for a detailed and meticulous examination of these patients to detect these various disorders.
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Affiliation(s)
- Vinitha V Panicker
- Department of Dermatology, Amrita Institute of Medical Sciences and Research Centre, Edappally, Ernakulam, Kerala, India.
| | - Najeeba Riyaz
- Department of Dermatology, Government Medical College, Calicut, Kerala, India
| | - P K Balachandran
- Department of Dermatology, Government Medical College, Alappuzha, Kerala, India
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Bieber AK, Martires KJ, Driscoll MS, Grant-Kels JM, Pomeranz MK, Stein JA. Nevi and pregnancy. J Am Acad Dermatol 2016; 75:661-666. [DOI: 10.1016/j.jaad.2016.01.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 11/30/2022]
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Auriemma M, Di Nicola M, Varrati S, Carbone A, Pamio A, Capo A, Tracanna M, Castigliego AP, Tiboni GM, Amerio P. Mole modifications following controlled ovarian stimulation for assisted reproduction technologies. J Eur Acad Dermatol Venereol 2015; 29:1913-7. [PMID: 25879151 DOI: 10.1111/jdv.13065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 02/04/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The role of estrogens on moles biology remains undefined although estrogenic receptors have been found on melanocytes. It has been postulated that supraphysiological estrogen levels could promote the progression of moles to melanoma. Women undergoing controlled ovarian stimulation (COS) for assisted reproductive technologies (ART) are exposed to high levels of estrogens, produced by the ovary in response to exogenous gonadotropin administration. The aim of this study is to assess whether COS for ART may have an impact on mole structure and/or characteristics. METHODS Women undergoing to ART for various infertility conditions were included in the study. Personal and clinical data were collected. Dermatoscopic features and scores (total dermoscopy score--TDS) were statistically compared before COS and after a 6-month follow-up period. Statistical correlation was performed between estradiol, FSH blood levels and relative variation in moles dimensions. RESULTS A total of 46 patients were included in the study. One hundred and seventy-five melanocytic lesions from 31 patients were evaluated at both time points. Although statistically significant differences were found in mole dimension and TDS between the two time points, these differences had no relevance in the clinical setting not suggesting the need for mole excision. Moreover, the only statistically significant correlation with estradiol blood concentration on hCG administration day was found with one-axis dimensional variation. CONCLUSIONS To our knowledge this is the first work to evaluate the effect of COS on moles. The obtained results do not support a causal relation between the supraphysiological hormone levels stimulation and worsening of clinical and dermoscopical features of moles. Further study is needed to clarify whether estrogens plays a role in melanoma.
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Affiliation(s)
- M Auriemma
- Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - M Di Nicola
- Department of Experimental and Clinical Sciences, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - S Varrati
- Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - A Carbone
- L'Immacolata Hospital, Catholic University of the Sacred Heart, Celano (AQ), Italy
| | - A Pamio
- Department of Medicine and Aging Science, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - A Capo
- Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - M Tracanna
- Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - A P Castigliego
- Department of Medicine and Aging Science, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - G M Tiboni
- Department of Medicine and Aging Science, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - P Amerio
- Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
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Goldberg D, Maloney M. Dermatologic surgery and cosmetic procedures during pregnancy and the post-partum period. Dermatol Ther 2013; 26:321-30. [DOI: 10.1111/dth.12072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dori Goldberg
- Division of Dermatology; U of Mass Medical School; Worcester; Massachusetts
| | - Mary Maloney
- Division of Dermatology; U of Mass Medical School; Worcester; Massachusetts
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[Melanocytic nevi, melanoma, and pregnancy]. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:650-7. [PMID: 21530926 DOI: 10.1016/j.ad.2011.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 01/19/2011] [Accepted: 02/09/2011] [Indexed: 11/21/2022] Open
Abstract
Malignant melanoma is among the malignant tumors whose incidence has risen markedly in recent decades. For many years the medical community debated the potential adverse effects of female hormones (whether of exogenous or pregnancy-related endogenous origin), on melanocytic nevi and malignant melanoma. Given that women have been delaying pregnancy until their thirties or forties and that the incidence of malignant melanoma increases in those decades, the likelihood of this tumor developing during pregnancy has increased. Recent clinical and experimental evidence has suggested that pregnancy does not affect prognosis in malignant melanoma and that it does not seem to lead to significant changes in nevi. This review examines the relationship between malignant melanoma and hormonal and reproductive factors. Evidence was located by MEDLINE search (in PubMed and Ovid) for articles in English and Spanish for the period from 1966 to March 2010; additional sources were found through the reference lists of the identified articles.
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[Melanoma: A protective role of pregnancy? A case report and review of literature]. ANN CHIR PLAST ESTH 2010; 56:43-8. [PMID: 21106287 DOI: 10.1016/j.anplas.2010.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Accepted: 10/12/2010] [Indexed: 11/24/2022]
Abstract
Melanoma is actually one of the most common malignancies to be diagnosed during pregnancy. Nevertheless, the role of the pregnancy hormones on the melanoma course is not yet completely clear. We present the case of melanoma in a pregnant woman, with a particularly fulminant postpartum development. This raised the question of a possible protection by the pregnancy hormones against melanoma.
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Youn SH, Lee YW, Seung NR, Park EJ, Cho HJ, Kim KH, Kim KJ. Rapidly progressing malignant melanoma influenced by pregnancy. Int J Dermatol 2010; 49:1318-20. [PMID: 20964657 DOI: 10.1111/j.1365-4632.2009.04418.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sung Hwan Youn
- Department of Dermatology, College of Medicine, Hallym University, Hallym Sacred Heart Hospital, Gyeonggi-do, Korea
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Miller E, Barnea Y, Gur E, Leshem D, Karin E, Weiss J, Schneebaum S. Malignant melanoma and pregnancy: second thoughts. J Plast Reconstr Aesthet Surg 2009; 63:1163-8. [PMID: 19592319 DOI: 10.1016/j.bjps.2009.05.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 05/25/2009] [Accepted: 05/29/2009] [Indexed: 11/30/2022]
Abstract
Malignant melanoma (MM) was considered a hormone-sensitive tumour, and pregnancy was thought to increase its risk and cause faster progression and earlier metastasis. Several controlled studies demonstrated similar survival rates between pregnant and non-pregnant patients and concluded that early reports of advanced MM of pregnancy were probably due to late diagnosis. We retrieved information from our database between 1997 and 2006 on all patients diagnosed as having MM during and up to 6 months after pregnancy (n=11) and compared them to age-matched, non-pregnant, MM patients (n=65, controls) treated by us during that period. The mean Breslow thickness was 4.28mm for the pregnant patients and 1.69mm for the controls (p=0.15). The sentinel nodes were metastatic in five pregnant patients compared to four controls (p<0.0001). Two patients in the pregnancy group and one control died of MM (p=0.0532). Our results indicate a negative effect of pregnancy on the course of MM.
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Affiliation(s)
- Ehud Miller
- Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Goodson AG, Grossman D. Strategies for early melanoma detection: Approaches to the patient with nevi. J Am Acad Dermatol 2009; 60:719-35; quiz 736-8. [PMID: 19389517 DOI: 10.1016/j.jaad.2008.10.065] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 10/20/2008] [Accepted: 10/22/2008] [Indexed: 10/20/2022]
Abstract
UNLABELLED Given its propensity to metastasize and the lack of effective therapies for most patients with advanced disease, early detection of melanoma is a clinical imperative. Although there are no noninvasive techniques for the definitive diagnosis of melanoma, and the "gold standard" remains biopsy with histologic examination, a variety of modalities may facilitate early melanoma diagnosis and the detection of new and changing nevi. This article reviews the general clinical principles of early melanoma detection and various modalities that are currently available or on the horizon, providing the clinician with an up to date understanding of management strategies for their patients with numerous or atypical nevi. LEARNING OBJECTIVE After completing this learning activity, participants should understand the clinical importance of early melanoma detection, appreciate the challenges of early melanoma diagnosis and which patients are at highest risk, know the general principles of early melanoma detection, be familiar with current and emerging modalities that may facilitate early melanoma diagnosis and the detection of new and changing nevi, know the advantages and limitations of each modality, and be able to practice a combined approach to the patient with numerous or clinically atypical nevi.
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Cancer presenting during pregnancy: radiological perspectives. Clin Radiol 2009; 64:857-71. [PMID: 19664476 DOI: 10.1016/j.crad.2008.08.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 07/22/2008] [Accepted: 08/25/2008] [Indexed: 11/21/2022]
Abstract
Malignancy presenting during pregnancy is rare. When it does, there are important considerations and challenges for the radiologist. The physiological changes of pregnancy may mask signs and symptoms of malignancy leading to delayed presentation. Endocrine and physiological changes during pregnancy can interact with tumour biology to alter the behaviour and patterns of growth of certain tumours. The timing and choice of imaging technique pose potential risks to the foetus, but this must be weighed against the risks to both mother and foetus of inadequate investigation or misdiagnosis. This review outlines the general principles and approach to imaging the pregnant patient with suspected malignancy, following which there is a more detailed discussion of the effects of pregnancy on tumour biology and presentation of specific tumours. Imaging strategies are discussed for the different entities, and where possible, evidence-based imaging recommendations are made.
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Ruiz-Villaverde R, Sánchez-Cano D, Villaverde-Gutiérrez C. Bilateral naevus of Ota in a pregnant white woman. Clin Exp Dermatol 2009; 34:422-4. [PMID: 19309376 DOI: 10.1111/j.1365-2230.2008.03090.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lens M, Bataille V. Melanoma in relation to reproductive and hormonal factors in women: current review on controversial issues. Cancer Causes Control 2008; 19:437-42. [PMID: 18197460 DOI: 10.1007/s10552-008-9110-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 01/01/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE About one third of all melanoma in women occur during their childbearing age. An association between melanoma and hormonal and reproductive factors remains controversial. METHODS This article reviews current evidence on the link between melanoma and reproductive factors. A comprehensive search of Medline (from 1966 to July 2007) and Embase (1974 to July 2007) was performed. Articles were reviewed and additional references were obtained from the bibliographies. RESULTS Several controversial issues have been discussed. A pooled analysis of 10 case-control studies including a total of 5,590 women found a lack of association between melanoma risk and pregnancy. Data suggested that women with higher parity (five or more live births) had moderately lower melanoma risk compared with nulliparous women. Current evidence demonstrated that pregnancy did not appear to affect survival in women with melanoma. Based on the current evidence there is no reason to recommend deferral of subsequent pregnancy in women in whom a primary melanoma is diagnosed during pregnancy. The data revealed no relation between melanoma risk and use of oral contraceptives and hormone replacement therapy (HRT). CONCLUSION Exogenous or endogenous female hormones do not contribute significantly to increased risk of melanoma. Melanoma prognosis does not appear to be affected by pregnancy. Termination of pregnancy in women diagnosed with a primary melanoma during pregnancy is not recommended. There is no evidence to support deferral of pregnancy in women with melanoma history except that at the end of 2 years patients have a better estimate of their risk of recurrence.
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Affiliation(s)
- Marko Lens
- Twin Research and Genetic Epidemiology Unit, King's College London, St. Thomas' Hospital Campus, Lambeth Palace Road, London, SE1 7EH, UK.
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Hoekstra HJ. Melanoma during pregnancy: therapeutic management and outcome. Recent Results Cancer Res 2008; 178:175-181. [PMID: 18080452 DOI: 10.1007/978-3-540-71274-9_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- H J Hoekstra
- Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
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Nading MA, Nanney LB, Boyd AS, Ellis DL. Estrogen receptor beta expression in nevi during pregnancy. Exp Dermatol 2008; 17:489-97. [PMID: 18177352 DOI: 10.1111/j.1600-0625.2007.00667.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Estrogen levels increase during pregnancy and clinical evidence has long suggested that melanocytes are estrogen-responsive. We hypothesized that nevi from pregnant patients would exhibit increased expression of estrogen receptor beta (ERbeta) and thus enhanced potential to respond to altered estrogen levels. Normal, dysplastic and congenital nevi (n = 212) were collected from pregnant and non-pregnant women ranging from 18 to 45 years of age. Immunohistochemical staining was performed on these nevi using antibodies specifically directed against estrogen receptor alpha (ERalpha) and ERbeta. ERalpha was not observed in any lesions; thus, ERbeta was the predominant estrogen receptor in melanocytic cells from all types of nevi. Enhanced positivity for ERbeta in normal nevi during pregnancy was noted, compared with non-pregnant controls including nevocytes residing in both the epidermal and dermal micro-environments (P = 0.005 and P = 0.001 respectively). Nevi with increasingly melanocytic atypia showed increased ERbeta in nevocytes nested within the epidermis. No additional increase in ERbeta in atypical nevi was observed during pregnancy. For normal and congenital nevi, regardless of pregnancy status, dermally associated nevocytes tended to have greater ERbeta immunoreactivity. Significant decreases in ERbeta immunoreactivity were observed in congenital nevi from pregnant women compared with normal and dysplastic nevi from pregnant women. Our data suggest that nevi possess the capacity to be estrogen-responsive. Factors such as pregnancy and degree of atypia are associated with enhanced ERbeta with the exception of congenital nevi where the melanocytes were unique in their response to pregnancy.
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Affiliation(s)
- Mary Alice Nading
- Department of Medicine, Division of Dermatology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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Aktürk AS, Bilen N, Bayrämgürler D, Demirsoy EO, Erdogan S, Kiran R. Dermoscopy is a suitable method for the observation of the pregnancy-related changes in melanocytic nevi. J Eur Acad Dermatol Venereol 2007; 21:1086-90. [PMID: 17714130 DOI: 10.1111/j.1468-3083.2007.02204.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND It is a common opinion that expansion and darkening in melanocytic nevi may occur during pregnancy. The main problem is that whether it is a usual finding, or it is a condition that requires suspicion about melanoma. OBJECTIVES It was aimed to find the changes that might occur in the sizes and structures of melanocytic nevi during pregnancy. METHODS Ninety-seven nevi of the 56 pregnant women in the first trimester were evaluated in the study. The localization and size of the nevi were recorded on a standard body diagram. After clinical examination, dermoscopic analyses were applied. Pattern analyses were done, and total dermoscopy scores (TDS) were calculated by applying ABCD scoring system. All subjects were seen again during the third trimester. RESULTS There was a statistically significant difference between the mean diameters of nevi in the first and third trimester (P = 0.001). Of nevi whose diameters increased, 10 (50.00%) were localized on the front of body, 6 (30.00%) on the face and neck, 3 (15.00%) on the legs, and 1 (5.00%) on the back. The enlargement in diameters was more significant on the front of the body, but there was no statistically significant difference. Compared according to the pattern analysis, new dot formation was observed only on the structure of six nevi during the last trimester. Four of them were localized on the front of the body. There was statistically significant increase in mean TDS in comparison between the first and third trimesters (P = 0008). CONCLUSIONS During the pregnancy, widening in diameters and structure changes of nevi may be seen especially on the front of the body. We also think that these findings might be connected with expansion of the skin during pregnancy. Dermoscopic controls are the first choice of method to analyse the nevi since the patient may not recognize these changes.
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Affiliation(s)
- A S Aktürk
- Department of Dermatology, Kocaeli University School of Medicine, Kocaeli/Turkey, Turkey.
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Hormones, nevi, and melanoma: An approach to the patient. J Am Acad Dermatol 2007; 57:919-31; quiz 932-6. [DOI: 10.1016/j.jaad.2007.08.045] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 08/05/2007] [Accepted: 08/31/2007] [Indexed: 12/22/2022]
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Bollos RH, Nakamura MU, Lapchick VBV, Bevilacqua EMAF, Correa M, Daher S, Ishigai MMS, Jasiulionis MG. Metastatic melanoma positively influences pregnancy outcome in a mouse model: could a deadly tumor support embryo life? Clin Exp Metastasis 2007; 25:65-73. [DOI: 10.1007/s10585-007-9102-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 09/21/2007] [Indexed: 12/31/2022]
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Rubegni P, Sbano P, Burroni M, Cevenini G, Bocchi C, Severi FM, Risulo M, Petraglia F, Dell'Eva G, Fimiani M, Andreassi L. Melanocytic skin lesions and pregnancy: digital dermoscopy analysis. Skin Res Technol 2007; 13:143-7. [PMID: 17374054 DOI: 10.1111/j.1600-0846.2007.00180.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Very few studies have tried to clarify how pregnancy influences the morphology of pigmented skin lesions (PSL). Our purpose was to objectively determine, by digital dermoscopy analysis (DDA), any dermoscopic changes of acquired melanocitic nevi during pregnancy and after 1 year from delivery. METHODS Thirty-five healthy pregnant women and 35 age-matched female controls were enrolled in the study. Nevi of pregnant women were analysed by DDA between 5 and 8 weeks of pregnancy, between 39 and 41 weeks of pregnancy and 12 months after delivery. Nevi of control women were analysed by DDA in a month of the year matching the period of recruitment of pregnant women and 21 months later. RESULTS Multivariate analysis of variance (manova) for repeated measures revealed that dermoscopic variables SKIN-GREEN-AVERAGE, SKIN-BLUE-AVERAGE and CONTRAST changed during pregnancy but returned to non-significant values after a year from delivery. The variable ENTROPY showed significant differences between initial evaluation and 1 year after delivery. Finally, the variable VARIANCE OF BORDER GRADIENT showed a significant difference between the first and the last evaluations, in both pregnant and control subjects. CONCLUSIONS The study showed that pregnancy leads to significant modifications in PSL, especially with regard to pigment network, globules and architectural order or disorder.
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Affiliation(s)
- Pietro Rubegni
- Department of Clinical Medicine and Immunological Sciences, Section of Dermatology, University of Siena, Siena, Italy.
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Zampetti A, Feliciani C, Landi F, Capaldo ML, Rotoli M, Amerio PL. Management and dermoscopy of fast-growing nevi in pregnancy: case report and literature review. J Cutan Med Surg 2007; 10:249-52. [PMID: 17234109 DOI: 10.2310/7750.2006.00047] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The relationship between pregnancy and a change in melanocytic nevi is still controversial. Moreover, management of the rapid evolution of a nevus in an unauspicious melanocytic lesion can be a clinical challenge in pregnancy. METHODS This article examines a case of a fast-growing deep penetrating nevus in a pregnant woman and provides a literature review of articles relative to pregnancy and nevi change, the management of fast-growing pigmented lesions, and the role and usefulness of dermoscopy in these cases. RESULTS Recent studies have documented that pregnancy is not associated with any significant change in the size of melanocytic nevi. The management of fast-growing melanocytic lesions during this period compulsorily leans toward excision. Dermoscopy can be useful, providing clinicohistopathologic correlations and a better assignment of the lesion. CONCLUSION This case report and review provide important management considerations for nevi during pregnancy. Early intervention with aggressive treatment measures is the best management for fast-growing lesions, and epiluminescence dermoscopy can assist the management, although still remaining a second-level examination, useful for documentation and for a better classification of the lesion.
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Affiliation(s)
- Anna Zampetti
- Istituto di Dermatologia, Catholic University of the Sacred Heart, Rome, Italy.
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Zampino MR, Corazza M, Costantino D, Mollica G, Virgili A. Are melanocytic nevi influenced by pregnancy? A dermoscopic evaluation. Dermatol Surg 2007; 32:1497-504. [PMID: 17199661 DOI: 10.1111/j.1524-4725.2006.32362.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermoscopic data of melanocytic nevi (MN) in pregnancy are very limited and related to small groups of women. OBJECTIVE This study systematically analyzes dermoscopic parameters in a wide series of MN during and after pregnancy. METHODS Eighty-six MN on the back of 47 women were studied. Dermoscopic parameters, total dermoscopic score (TDS) according to Stolz's ABCD rule, and the sizes of the nevi were evaluated over time. RESULTS Progressive lightening of the nevi resulted at the end of pregnancy (p<.05) and after delivery (p<.001). Pigment network showed a progressive reduction in prominence and thickness (end of pregnancy, p<.05; after delivery, p<.01). At the end of pregnancy, vessels increased (p<.05) and a higher TDS was observed, with a significant reduction in both after delivery (vessels, p<.05; TDS, p<.01). Area changes were not statistically significant. CONCLUSIONS At the end of pregnancy, both vascular structures and TDS increased. These modifications were transient as the nevi recovered their prior appearance after delivery. The results indicate that an intrinsic influence of pregnancy may induce structural modifications without influencing the size of the nevi. Behavioral factors during the observational period, like a reduced exposure to sunlight reported by most of the women, may have influenced other characteristics, like global pigmentation and pigment network. The authors thank the Fondazione Cassa di Risparmio di Ferrara for its financial support, which enabled them to acquire the instrumentation necessary for this study.
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Affiliation(s)
- Maria Rosaria Zampino
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Ferrara, Ferrara, Italy
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Abstract
The influence of pregnancy on melanocytic nevi and malignant melanoma (MM) continues to be a controversial issue. Over the past 50 years, case reports and uncontrolled studies have suggested that nevi are more likely to become malignant during pregnancy, and MM diagnosed during pregnancy has a poor prognosis. Clinical and laboratory observations suggested that pregnancy-associated hormones may influence nevi and MM. Recent clinical and laboratory evidence suggests, however, that pregnancy does not influence the prognosis of MM, nor does it seem to cause significant changes in nevi. A clear link between hormones and MM has not been established. An analysis of this evidence is presented along with practical recommendations for the patient.
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Affiliation(s)
- Marcia S Driscoll
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT 06030, USA
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Abstract
Pregnancy affects all organ systems in the body, including the skin. Some skin changes are physiological, whereas others such as the dermatoses of pregnancy are pathological. Dermatologists regularly encounter pregnant patients, and the identification of normal skin changes and their differentiation from disease states are essential to insure the well-being of both mother and fetus. This review discusses the physiological skin changes in pregnancy, including alterations in pigmentation, hair, nail, and connective tissue, as well as vascular and hematologic changes and modulation of glandular function.
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Affiliation(s)
- Maya M Muallem
- Department of Dermatology, American University of Beirut Medical Center, Beirut 113-6044, Lebanon
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Pentheroudakis G, Pavlidis N. Cancer and pregnancy: Poena magna, not anymore. Eur J Cancer 2006; 42:126-40. [PMID: 16326099 DOI: 10.1016/j.ejca.2005.10.014] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Accepted: 10/06/2005] [Indexed: 01/02/2023]
Abstract
Cancer diagnosed during pregnancy constitutes a difficult clinical condition with a devastating impact on the patient's somatic and psychosocial health and possibly on foetal integrity. This circumstance also raises several moral, religious, social and familial dilemmas. In this review we critically present available evidence regarding the incidence, epidemiology and genetics of cancer in pregnant women, its presentation, diagnosis and staging as well as therapeutic management. Issues such as maternal/foetal prognosis, need for termination of pregnancy, risk of foetal health injury and necessity of psychosocial support are reviewed. Recent accumulating evidence suggests that, with appropriate management, poena magna should not be used to define neither cancer nor pregnancy.
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Affiliation(s)
- George Pentheroudakis
- Department of Medical Oncology, Ioannina University Hospital, University of Ioannina, 45 110 Ioannina, Greece
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Abstract
The development of melanocytic nevi is a multifactorial and heterogeneous biologic process that involves prenatal and postnatal steps. As a consequence, there are two main perspectives to nevi: that of a hamartoma and that of a benign tumor. In this review, dermatopathological studies on congenital and acquired nevi, including studies on age-related and location-dependent changes, are analyzed. These studies have lead to different hypothetical concepts on the evolution of individual lesions. In the light of findings from experimental embryology and stem cell biology, we discuss the histogenesis of nevi with special reference to the temporospatial sequence of melanocyte-basement membrane interactions and hair follicle genesis. Regarding the mechanisms of postnatal nevus development, epidemiological studies demonstrate the importance of constitutional and environmental influences, especially ultraviolet light. Possible molecular pathways of solar nevogenesis involve ultraviolet-induced alterations of the cellular microenvironment (eg, changes in the expression of cytokines and melanocyte adhesion molecules). Recent results and future directions of clinical and experimental research are presented.
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Affiliation(s)
- Sven Krengel
- Department of Dermatology, University of Lübeck, Germany.
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Abstract
Neste estudo conduz-se uma revisão bibliográfica da literatura sobre dermatologia e gravidez abrangendo o período de 1962 a 2003. O banco de dados do Medline foi consultado com referência ao mesmo período. Não se incluiu a colestase intra-hepática da gravidez por não ser ela uma dermatose primária; contudo deve ser feito o diagnóstico diferencial entre suas manifestações na pele e as dermatoses específicas da gravidez. Este apanhado engloba as características clínicas e o prognóstico das alterações fisiológicas da pele durante a gravidez, as dermatoses influenciadas pela gravidez e as dermatoses específicas da gravidez. Ao final apresenta-se uma discussão sobre drogas e gravidez.
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Lens MB, Rosdahl I, Ahlbom A, Farahmand BY, Synnerstad I, Boeryd B, Newton Bishop JA. Effect of pregnancy on survival in women with cutaneous malignant melanoma. J Clin Oncol 2004; 22:4369-75. [PMID: 15514378 DOI: 10.1200/jco.2004.02.096] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE An adverse influence of pregnancy on the risk of death in women with cutaneous melanoma was suggested historically by anecdotal reports. Previous studies included small numbers of women observed for short periods. METHODS Using data from the Swedish National and Regional Registries, we performed a retrospective cohort study of all Swedish women who were diagnosed with cutaneous melanoma during their reproductive period, from January 1, 1958, to December 31, 1999. The relationship between pregnancy status at the diagnosis of melanoma and overall survival was examined in multivariable proportional-hazards models. RESULTS The cohort comprised 185 women (3.3%) diagnosed with melanoma during pregnancy and 5,348 (96.7%) women of the same childbearing age diagnosed with melanoma while not pregnant. There was no statistically significant difference in overall survival between pregnant and nonpregnant groups (log-rank chi(2)1[r] = 0.84, P = .361). Pregnancy status at the time of diagnosis of melanoma was not related to survival in a multivariable Cox model in the 2,101 women (hazard ratio for death in the pregnant group was 1.08; 95% CI, 0.60 to 1.93). In the multivariable analysis, pregnancy status after diagnosis of melanoma was not a significant predictor of survival (hazard ratio for death in women who had pregnancy subsequent to the diagnosis of melanoma was 0.58; 95% CI, 0.32 to 1.05). CONCLUSION The survival of pregnant women with melanoma is not worse than the survival of nonpregnant women with melanoma. Pregnancy subsequent to the diagnosis of primary melanoma was not associated with an increased risk of death.
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Affiliation(s)
- Marko B Lens
- Genetic Epidemiology Division, Cancer Research UK, St James's University Hospital, Beckett St, Leeds LS9 7TF, UK.
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Potic-Zecevic N, Stanojevic Z, Markovic M, Todorovska I, Stanojevic M. Pregnancy and melanoma. ARCHIVE OF ONCOLOGY 2004. [DOI: 10.2298/aoo0404206p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Numerous malignant diseases reach their incidence peak in female fertile years. That is the reason why these diseases are the second most common cause of death of women in their generative age. However, neoplastic processes are rarely diagnosed in pregnancy and there are no clear-cut guidelines on whether the pregnancy should be terminated in order that a proper treatment could be applied. We have not enough knowledge jet about the consequences for both the mother and her child if the pregnancy is allowed to continue despite the diagnosis of malignancy. Melanoma is one of the most common tumours diagnosed in pregnancy (8% of all diagnosed neoplasms). Some studies present the data on successfully terminated pregnancies in these women but also point out the risks the fetus is exposed to due to possible application of cytotoxic therapy, as well as the danger of transplacental spread of this process to the placenta and fetus.
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Vazquez-Lopez F, Manjón-Haces JA, Lopez-Escobar M, Perez-Oliva N, Marghoob AA. Sequential image analysis and measurement of pigmented lesions: false variations due to patient positioning. Clin Exp Dermatol 2003; 28:657-60. [PMID: 14616836 DOI: 10.1046/j.1365-2230.2003.01409.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical researchers are evaluating the utility of obtaining sequential images of pigmented lesions taken over time for purposes of comparison with the aim of detecting subtle changes suggestive of melanoma. Therefore, the image acquisition process is critical and will need to be strictly standardized before any firm conclusions can be drawn from analysis of sequential images. The influence of patient positioning on the accuracy of sequential image analysis has not been considered in most studies evaluating sequential images. In this experimental study, the influence of patient positioning on the size and shape of an inked circle placed on the skin was determined and measured. Inked circular marks (15 mm in diameter, area 176.71 mm2) were placed on the skin of the lumbar and suprascapular areas of 60 consecutive patients. The diameter and area of the 'circle' was measured with the patient in the prone position with head centred, prone position with head turned to the right, prone position with head turned left, and in the seated position. Statistical analysis was performed with Student's t-tests (paired data). We observed statistically significant differences in the shape, mean maximal diameter and area of the inked circular marks on both the suprascapular area and in the lumbar area after changes of patient positioning (P<0.001). To conclude, the position of the patient must be fixed and standardized during acquisition of sequential images, at least for lesions 15 mm in diameter or larger. Furthermore, it is our opinion that the methods used to control for patient positioning should be reported in the methodology section of studies that report on comparison of sequential images. Only then can we accurately compare sequential images and avoid 'false positive lesion enlargement' being categorized as a true change.
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Affiliation(s)
- F Vazquez-Lopez
- Department of Dermatology, Central University Hospital, Oviedo, Spain.
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de Braud F, Khayat D, Kroon BBR, Valdagni R, Bruzzi P, Cascinelli N. Malignant melanoma. Crit Rev Oncol Hematol 2003; 47:35-63. [PMID: 12853098 DOI: 10.1016/s1040-8428(02)00077-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In the European Community cutaneous melanoma accounts for 1 and 1.8% of cancers occurring in men and women, respectively. The incidence rate is increasing faster than that of any other tumour. Sun exposure, patient's phenotype, family history, and history of a previous melanoma are the major risk factors. The change over a period of months is the main sign of a skin lesion turned into a melanoma. The ABCDE scheme for early detection of melanoma is commonly accepted. A new staging classification will be published in the next AJCC/UICC Cancer Staging System Manual in 2002. The clinical course of melanoma is determined by its dissemination and depends on thickness, ulceration, localisation, gender and histology of the primary tumour. Tumour stage at diagnosis remains the major prognostic factor. Surgery is the standard treatment option for operable local-regional disease. Sentinel node biopsy represents a promising experimental approach in the clinical detection and early treatment of occult lymph node involvement. For metastatic inoperable patients systemic chemotherapy can be attempted, while radiation therapy has to be considered as palliative treatment. No studies concerning frequency of follow-up are currently available, but common procedures may be performed.
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Daryanani D, Plukker JT, De Hullu JA, Kuiper H, Nap RE, Hoekstra HJ. Pregnancy and early-stage melanoma. Cancer 2003; 97:2248-53. [PMID: 12712479 DOI: 10.1002/cncr.11321] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cutaneous melanomas are aggressive tumors with an unpredictable biologic behavior. It has been suggested that women who present with melanoma during pregnancy have a worse prognosis due to more aggressive behavior of the melanoma. The objective of the current study was to evaluate the long-term effect of pregnancy on disease progression in women with Stage I-II melanoma. METHODS From 1965 to 2001, 46 pregnant women were treated for a Stage I-II melanoma at the University Medical Center Groningen. These patients were compared with an age-matched and gender-matched control group (nonpregnant) of 368 women with Stage I-II melanoma. The patients were staged according to the 2002 American Joint Committee on Cancer TNM classification system for melanoma. The 10-year disease-free survival (DFS) and 10-year overall survival (OS) rates were calculated using logistic regression analysis. RESULTS The median age of patients in the pregnant group was 30 years (range, 18-46 years), and the median age of patients in the nonpregnant group was 36 years (range, 17-45 years). The median follow-up was 109 months (range, 1-356 months). Pregnant patients presented more often with thicker melanomas (median, 2.0 mm vs. 1.7 mm; not statistically significant). No differences with regard to tumor location, histologic subtype, tumor ulceration, or vascular invasion were detected between the pregnant group and the nonpregnant group. There was no statistical difference in the 10-year DFS and 10-year OS rates between the two groups. The 10-year DFS rates for patients in the pregnant and nonpregnant groups, respectively, were 88% versus 86% for patients with Stage I melanoma and 67% versus 73% for patients with Stage II melanoma. The 10-year OS rates for patients in the pregnant and nonpregnant groups, respectively, were 94% versus 90% for patients with Stage I melanoma and 82% versus 81% for patients with Stage II melanoma. CONCLUSIONS Pregnancy does not appear to have an adverse, long-term effect on survival in patients with clinically localized melanoma. Further studies should address whether pregnant patients present with thicker lesions and/or whether they have decreased DFS compared with nonpregnant women. The prognosis for women with melanoma during pregnancy, as it relates to survival, still is dependent on tumor thickness and ulceration.
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Affiliation(s)
- Deepu Daryanani
- Division of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands
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Gunduz K, Koltan S, Sahin MT, E Filiz E. Analysis of melanocytic naevi by dermoscopy during pregnancy. J Eur Acad Dermatol Venereol 2003; 17:349-51. [PMID: 12702085 DOI: 10.1046/j.1468-3083.2003.00792_2.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Physiologic skin changes are common during pregnancy due to a temporary shift in hormonal, metabolic, and immunologic factors. Physicians may mistake normal skin changes in pregnancy as pathologic change within the skin, and so an appreciation of the common and less common skin manifestations will assist in appropriate patient care. OBJECTIVE This review highlights the normal physiologic skin changes in pregnancy, which include pigmentary changes, changes to the hair and nails, alterations in glandular activity, vascular and hematological changes, cutaneous tumors, and mucous membrane changes. CONCLUSION Physiologic changes to the skin in pregnancy can be complex and confusing. Pregnancy can be a stressful time for women so it is imperative that physicians be aware of the normal skin changes during pregnancy in order to prevent unnecessary investigations and treatments.
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Affiliation(s)
- Benjamin Barankin
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
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Katz VL, Farmer RM, Dotters D. Focus on primary care: from nevus to neoplasm: myths of melanoma in pregnancy. Obstet Gynecol Surv 2002; 57:112-9. [PMID: 11832787 DOI: 10.1097/00006254-200202000-00023] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Malignant melanoma is one of the few malignancies that regularly affect women during their childbearing years. Additionally, the incidence of melanoma has been increasing over the last several decades. Early diagnosis of stage I disease may lead to curative therapy; thus it is important for physicians and midwives to do a full examination of the skin. However, the myth that nevi may naturally grow or change during pregnancy has been shown not to be true and should not delay a diagnostic evaluation of a suspicious nevus. Older studies had theorized a worse outcome for pregnant women with melanoma. However, multiple controlled series and investigations have found that stage for stage this cancer is not affected adversely by pregnancy. Prognosis, recurrence, and incidence of melanoma seemed to be unaffected. Estrogen-containing oral contraceptives, as well as hormone replacement therapy, have no adverse affect on the disease.
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Affiliation(s)
- Vern L Katz
- Department of Obstetrics, Oregon Health Sciences University, Eugene 97401, USA.
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Affiliation(s)
- C M Grin
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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